Strengthen 2 indigenous NSA to support the Yi minority in Butuo County (China’s alarmingly high HIV infected county) to take control of the epidemic

The publication have been produced implementing the project "Strengthen 2 indigenous NSA to support the Yi minority in Butuo County (China’s alarmingly high HIV infected county) to take control of the epidemic " (DCI-NSAPVD/2013/316-

The publication have been produced implementing the project "Strengthen 2 indigenous NSA to support the Yi minority in Butuo County (China’s alarmingly high HIV infected county) to take control of the epidemic " (DCI-NSAPVD/2013/316-080). The content of this publication are the sole responsibility of authors and can in no way be taken to reflect the views of the European Union.

HPPB - EC

Strengthen 2 indigenous NSA to support the Yi minority in Butuo County (China’s alarmingly high HIV infected county) to take control of the epidemic (DCI-NSAPVD/2013/316-080)

Role of civil society and non-governmental sector organizations (NGOs) in Lithuania

The core mandate of non-state actors (NSA) is to translate the political recognition of civil society organizations into an enabling environment in development, demonstrated by funding of a high quality and quantity and by political, regulatory and policy influencing space. The activities of NGOs in Lithuania cover various areas that are beneficial to society and important for the successful development of the state, e.g. healthy life style promotion and fighting social exclusion, development of social service, and promotion of international cooperation.

Strong and competent NGOs represent the country at international organizations, promote volunteering, increase civic and corporate social responsibility, and attract funds from private sponsors and international foundations and organizations, or by carrying out commercial activities, thereby creating both social and economic value for the state. The chief obstacles to the development of the non-governmental sector are a lack of active citizenship, poor NGO administrative and financial resources, and underdeveloped cooperation between NGOs and public authorities.

HIV spread in three Baltic countries

Figure 1

The first HIV case in Lithuania was registered in 1988. By 2015, HIV positive in Lithuania are 2 378 persons - 1902 males and 476 females (4/5 male, 1/5 female). It makes 76 HIV positive among 100 000 people. It is much less than in two neighboring Baltic region countries – 8 times less than in Estonia (633) and 4 times less than in Latvia (270). 66% IDU, 17% hetero sex, 7% homo sex, 0,1% PMTC and 10.2% - unknown. Age group 30-34 years, the youngest infected is 17 years old and the oldest – 68 years old. In Lithuania, HIV spread is mainly over three areas, in three major cities: Vilnius (capital city) 531, Klaipeda (port and third large city) 563 and Kaunas (second large city) 206.

Figure 2

HIV in Lithuania is not widely spread and the public to large extent is unaware of the challenge and innocently believe that only specific group of people is exposed to the virus. The spread is mainly concentrated among people who inject drugs (PWID) and prison inmates, i.e. two overlapping sub-groups. However, the situation is changing. Figure 3 shows in percent the PWID infections to the total. In 2014, new 141 infections: 90 males and 51 females.

Figure 3

Analysis of the number of persons who got HIV infected injecting narcotic and psychoactive substances reveals a declining tendency. In 2014, the exposure through drugs (PWID) is 27% and through sex – is twice: 54.6%. The trend is a serious challenge to the existing practise of fighting HIV in Lithuania.

Policy fighting HIV/AIDS

On drugs. The National Program on Drug Control and Prevention of Drug Addiction, 2010–16 was endorsed by the Lithuanian Parliament on 10 November 2010. The overarching goal of the Program is to reduce the supply and demand for illicit drugs and psychotropic substances and their precursors, as well as the spread of drug addiction, by strengthening individual and public education, health and safety. Several priorities are included in the national Program addressing: drug demand reduction among children and youth in particular; drug supply reduction; drug use monitoring; information; and coordination and international cooperation. The Program is constructed around two pillars covering the areas of supply and demand reduction and two cross-cutting themes focus on coordination and cooperation, and information and research. Primarily, the Program is concerned with illicit drugs.

On HIV. International organizations recommend implementation of at least four means: distribution of needles, rapid testing, methadone program and education. The National Program for Control and Prevention of Infectious Diseases for 2015-2019. The aim – to prevent the spread of HIV and sexually transmitted diseases. Prevalence of HIV, HBV, HCV among IDUs’ sexual partners is low, but it is high among IDUs. Unprotected sex can lead to spread of HIV and other infections from risk groups to the general population. It is necessary to strengthen Sexually Transmitted Infection (STI) prevention among bridging population. Annual National Report, produced by the national focal point of the Reitox network, following the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) guidelines, draw an overall picture of the drug phenomenon at national level. National Report 2013 focused mainly on prevalence, incidence and patterns of drug use, responses to the drug situation and consequences of drug use.

Treatment. Out of total 2 378 HIV positive in Lithuania, under treatment are 491 patients, i.e. 21% Currently, implementing the National Drug Control and Drug Prevention Program 2010-2016, adopted by Seimas (The National Parliament) resolution No. XI-1078 on 4 November 2010, the National Drug, Tobacco and Alcohol Prevention Interinstitutional Action Plan is approved; 42 thousand EUR from the national budget is allocated annually to low-threshold services. Free blood testing is for a) blood donors, b) pregnant women and c) prison inmates. The Testing Program does not specify IDU and sex workers, the main HIV risk groups. Blood samples are repeatedly sent to the National Public Health S

Surveillance Laboratory. Financing for compensation of anti-retro virus treatment and AIDS medicine, HIV monitoring, adaptation of low-threshold services of medical cabinets. People with HIV infection or virus carriers are covered by public health insurance from public funds and can get reimbursement for antiretroviral therapy. Public spending on drug related expenditure is falling: after 2011 the overall annual budget approved at the beginning of every fiscal year declined as a proportion of GDP, from 0.013 % GDP in 2011 to an estimated 0.002 % in 2013. Free HIV testing is not so easily accessible, especially in the regions. HIV testing is paid (8-12 EUR) and available only when family’s physician orders it because of the symptoms of any disease induction, whose presence raise suspicion of HIV. Free HIV test is offered only by few NGOs as a private initiative, and not reimbursed by the public health system. In 2013, the Department of Prisons and the National Public Health Care Laboratory concluded the Agreement on provision of services for serological blood tests concerning HIV and other sexually transmitted diseases. In 2014, 15 388 tests were carried out for detection of the HIV virus. Each of the 60 municipalities has a Municipality Drug Control Commission. Municipal commission coordinates different actions, such as prevention, treatment and harm reduction. Municipal institution Health Centre task: to implement prevention and control of communicable diseases. There are five regional public specialized Centres for Addictive Disorders. The center's offer treatment of one to three months by group psychotherapy, acupuncture and counseling.

Prevention

Drug use. The Lithuanian Drug Strategy prioritizes the prevention of drug use in the family, among children and youths. In 2011 the Resolution of the Parliament of the Republic of Lithuania, On Targeted Policy of Prevention and Control of Drugs, Tobacco and Alcohol Consumption, prioritises the development of mature values and building healthy life skills among children and young people through integrated and evidence based prevention programmes. Drug prevention activities are focused mainly on prevention measures at local communities and schools, aiming to protect young people from drug use. Education. In 2013-2015 the Centre of Special Pedagogy and Psychology implemented the project Development of a Safe Environment in School. The project envisaged prevention of HIV/AIDS via development of healthy life style skills. For the time being, the executive document of the Ministry of Education and Science is the Decree Concerning Prevention of Infringements of Law, Absence from School, Narcotic and Psychotropic Substance Use, HIV/AIDS, Violence and Criminal Offence. NGOs. The Ministry of Health highly appreciates the work of NGOs on HIV / AIDS issues. The cooperation and partnership with NGOS, envisaged in the Draft Action Plan and contributes to the continuity and strengthening of fighting HIV/AIDS in Lithuania. NGOs engaged in fighting HIV/AIDS: “Demetra” (demetra.lt) and “Positive life” (www.hiv.lt) and others. National NGOs coalition “I can live”. The national coalition engages HIV positive persons in policy and activities’ levels. E.g. National Coalition is concerned for the absence of comprehensive study of impact of previous programs. The Program for 2015-2017 is lacking specific aims and monitoring marks, clarity regarding the implementation of the measures, it is not clear who is taking responsibility for the results.

Challenges and conclusions

In Lithuania since 2015 we are aware the HIV is spreading increasingly among very young. The need to review the existing HIV fighting strategy and start to pay more attention for safe sex education become more obvious. Safe sex education at public schools become a hot potato. The issue continues to be debated by various shareholders but with little effects. The Ministry of Education established a Working Group on Health and Sexual Education and Family training. Emphasis on family values education essentially and pro marriage with divorce prevention. From their point of view, the best prevention tool is abstinence and teachers should avoid all kinds of contraception advocacy and speaking about the disease. For the time being, safe sex education is out of the national curricula. That leads to make two concussions: • Because of effective prevention campaigns and programs, HIV spread via intravenous drug use is decreasing. • Because of neglect of safe sex education, HIV spread via sex is – and will be - increasing.

The publication have been produced implementing the project "Strengthen 2 indigenous NSA to support the Yi minority in Butuo County (China’s alarmingly high HIV infected county) to take control of the epidemic " (DCI-NSAPVD/2013/316-080). The content of this publication are the sole responsibility of authors and can in no way be taken to reflect the views of the European Union.

EC-HPPB TCE Butuo

Strengthen 2 indigenous NSA to support the Yi minority in Butuo County (China’s alarmingly high HIV infected county) to take control of the epidemic

Context

Butuo County of Liangshan Yi Autonomous Prefecture in the southern mountains of Sichuan Province had 3-15% HIV infection rates in its 30 townships, presenting the highest generalized epidemic point in China (compared to the national estimated HIV infection rate of 0.08%). Without the people’s own initiative and NSAs working as catalysts for change, the insufficient health system services are not delivering or protecting people’s right to health. Only by empowering the grassroots and local authorities will the people of Butuo County be able to control the epidemic.RationaleThe action strengthened the role and capacity of 2 indigenous NSA: Liangshan Yi for Empowerment Center and Butuo Women Federation (‘BTWF’), and engaged them in meaningful dialogue with government and decision-making at the local level. One aim of this action was to promote the role of and Government acceptance of NGO/CBO in China by showing a good example of NSA-LA cooperation on an imminent problem that can only be solved with and through civil society: prevention of HIV in a time of sexual transmissions. At the same time the action contributed to solve a major development issue for a very marginalized population outside of mainstream services.

Outcomes

Both NSAs were regularly trained and increased the capacity of the field staff, from the Field Officers going door to door to the project officers and coordinators. During the monthly training meetings, operation skills (such as rapid testing skill and community mobilization) and management skills (such as time management and financial management) were offered.The project team interacted 300,000 times with 100,000 people, increasing the HIV knowledge rate to more than 65% (3rd party evaluation in process). In addition, more than 4,500 small group trainings were done involving more than 140,000 attendants.This face to face home based interaction made 15,803 people to opt for voluntary counselling and testing over 3 years, or in average about 5,000/year, a 20 times fold of the pre-project situation.Women Living with HIV did not only receive house to house trainings, but also benefited via 54 “Women Positive Living Clubs” and direct support. Moreover, 842 volunteer based village health clubs were established to discuss health issues in the villages.Throughout the action there was close cooperation with Butuo CDC, Butuo Maternal and Child Health Care Service Centre, Butuo Health Bureau, Liangshan HIV Prevention and Control , Association, Liangshan CDC and Liangshan AIDS Office.Policy change promoted for HIV care, support and testing. HPP’s TCE working methods of door-to-door, face-to-face bilingual HIV training, Home-based Fast Test, ARV Trio and HIV Positives Clubs were acknowledged by the Prefecture AIDS Control Office as essential to get control of HIV in Liangshan.

Implementation issues

The Action contributed significantly to strengthen 2 indigenous NSA to support the Yi minority in Butuo County. The management ability of BTFW and Liangshan Yi for Empowerment Centre were strengthened via home testing implementation, clinic staff and village doctor training, community media, etc.. The TCE model was on 25.12.2016 incorporated into a Prefecture wide policy called ‘1+n’ where the health authorities will engage village based health workers (=N) under the leadership of the township clinic in charge (=’1’).

The publication have been produced implementing the project "Strengthen 2 indigenous NSA to support the Yi minority in Butuo County (China’s alarmingly high HIV infected county) to take control of the epidemic " (DCI-NSAPVD/2013/316-080). The content of this publication are the sole responsibility of authors and can in no way be taken to reflect the views of the European Union.

HPPB projects

Humana People to People Baltic (HPPB) is Lithuanian NGDO, member of the international Humana People to People (HPP) movement. As the name of the movement suggests, humanitarianism and partnership are two guiding principles there. The Movement originated in anti-apartheid and decolonization movements in sixties. The mission of the movement is international global development based on cooperation in the name of human solidarity. The overall aim of membership and partnership is to improve human daily life conditions in very poor countries. Development strategy and actions are implemented in the partnerships of the movement member organizations. Partnership among HPP member organisations means sharing resources and joining efforts in long term activities. Activities are systemic, organized on project basis. At a project level, member organisations engage into collaboration and partnership among themselves, with other NGDOs, businesses, government institutions and international organisations. At some point of specific projects, the local community is engaged to assume a role and a task.

Governments and international development organization agencies establish partnership with NGDOs programs and sponsor NGDOs projects. As a rule, sponsorship of these project expenditures is only in part. The other part of the project budget should be covered by the applicant organization. For HPP member organizations second hand clothes trade is an economical activity to raise funds for financing development and social responsibility projects fully or in part. At the same time, the choice of second hand clothes significantly reduces exploitation of natural resources and energy and effectively answers essential human need for clothes without excessive production of new clothes. With more than 15 years of experience in international development, HPPB is trusted as a successful applicant at the project calls issued by Europe Aid, the Ministry of Foreign Affairs of Lithuania and other agencies.

For more information on the international Humana People to People movement mission and strategy, the projects, member organisations and their activities look at the Federation’s web www.humana.org HPPB is a member of the international Humana People to People movement and takes part in the mission of the movement.

HPPB initiates, develops and implements development assistance projects or engages in partnerships with other organizations and acts at two levels: national and international. At national level, HPPB acts on basis of social partnership and implements projects in cooperation with Lithuanian NGOs as partners. At international level HPPB primarily is a partner in the mission of the international HPP movement. The actions there are partnership projects.

SOCIAL PARTNERSHIP in LITHUANIA

Actions at national level are developed and implemented by HPPB and/or other NGO. By engaging in partnership with Lithuanian NGOs, HPPB primarily seeks a) to strengthen the impact of the locally implemented small scale projects and b) to maximise the effectiveness of its sponsorship. The two main areas of HPPB engagement in development in Lithuania:

a) Education

b) Social assistance

In the area of education, HPPB primarily targets Lithuanian schoolteachers and works in partnership with institutions of national education system, mostly with the Centre for Education Development of the Ministry of Science and Education. The subject where HPPB engages is the Global Education, i.e. teaching on growing international global interdependency and building students’ capacity to encounter global challenges. In 2013-2014 HPPB implemented European Commission sponsored project Solidarity Schools in Baltic States.

In the area of social assistance, HPPB engages in partnership with local NGOs, working with children and young people, mostly from social risk families. HPPB seeks to assist local organizations to feed children better and teach them to cook and eat more healthy, i.e. healthy nutrition capacity building. This strategy was realized via program Feed me better! In total, 29 projects activities have been implemented in 2012-2014. In 2015, after three years in partnerships with 29 Lithuanian NGOs, the review of lessons learned and evaluation of results follows.

PARTNERSHIP PROJECTS

In 2015 HPPB is a partner in implementation of 72 partnership projects in 9 countries all over the world: in Africa, Asia and Latin America. Ownership of the Partnership Project is by the other organisation, member of the international HPP movement. The main directions of the partnership projects are four:

a) Farmers Clubs

b) Fighting Epidemics

c) Child Aid and Community Development

d) Education

Feed me better!

Feed me better is a social partnership program of HPPB implemented in partnership with local child and youth organizations. Outreach of the program: more than 1.000 children and youth of 18 municipalities all over Lithuania.

The strategy of Feed me better! is NGO capacity building program. The Program supports local NGOs working with children of social risk families. Program partners children and youth organisations receive support and assistance to improve the quality of their services in "learning-by-doing" and respond to emerging community needs, e.g. overweight among social risk families children. Feed me better! is implemented in collaboration with the Ministry of Social Security and Labour of the Republic of Lithuania. The University of Health Sciences is assisting the Program in monitoring its effectiveness.

All partnership kitchen activities are monitored on-line on daily basis. The scope of Feed me better! is more than one thousand children, who are engaged in healthy life style and cooking activities in 29 CCCs in 18 municipalities all over the country. To implement Program activities, in 2012-2014 HPPB transferred for 29 partners, local child organizations in total 180 thousands EUR.

Since the first years of activities in 1998, HPPB is responsive to Lithuanian social issues. Being concerned to improve its social responsibility performance, HPPB in 2009 initiated a pilot project “Hungry kids don’t care to learn”. The pilot was meant to explore the possibility to support nutrition of poor families children via public school cantina. After evaluating the pilot results and possibilities and listening to experts recommendations, the initial idea has been specified and partnership directed towards local Children Care Centres (CCC). In 2010 the HPPB prepared program guidelines and made a call for potential partners to submit project proposals to improve poor families children nutrition and teach them to cook. HPPB committed itself to assist CCCs with up 2 thousands EUR for one year project each.

After evaluation of submitted proposals, the HPPB signed 11 contracts with local CCC. At the end of the year 2011 and after reviewing the results and consulting with experts the HPPB doubled its support and announced a new call for proposals., what resulted in 22 contracts. At the end of the year, HPPB invited partners to discuss the possibility of three year period of 2012-2014. In 2012 the HPPB signed partnership contracts with 27 social organisations. The contract is an annual contract with a possibility to renew it for consecutive year. In 2013 and 2014 HPPB has extended partnership to 29 partners and contracts.

Farmers' Club

In 2015 HPPB is a partner in 12 Farmers' Club projects in China, India, Mozambique, Zambia and Zimbabwe

Farmers Club is a project based concept to train small-scale farmers in agriculture practices such as sustainable and conservation farming. The general aim of Farmers' Club activities is to assist small scale farmers with knowledge and skills and equip them to continue with farming under climate change. The aims of Farmers' Club project are to respond effectively to the actual needs of local farming communities, increase families' income and become integrated in the market economy. At trainings, the farmers get organized in groups around issues of exploring and sharing natural resources, securing the field inputs, marketing of their production. Other subjects are general knowledge and skills on nutrition, health and community development. The Farmers' Clubs project modality is constantly revised and improved.

Farmers' Club project participants majority are women. This way, the Club is women empowerment program. Each Club will design its aims. When women have a voice at setting activities plan, they are concerned for the well-being of the whole family and take care for issues like water and sanitation, nutrition, health and education.

Trainings at Farmers' Club project are organised to respond effectively to the actual family and community needs, possibilities and conditions of development. Therefore, one club will concentrate on crop husbandry, the other - on animal husbandry, another - on irrigation.

From managerial point of view, Farmers' Club is a set of activities to reach groups of 250 local farmers. The group leader is responsible to organize and deliver class and field trainings and is also facilitating the meetings and assisting the farmers in their mutual collaboration and self-organization. This way the resilient structure of farmers' cooperation are established.

Farmers' Club could be also evaluated as a facility to effective implementation of national assistance to small scale farmers program. Public farming and agriculture development service programs are easily integrated in Farmers' Club project with mutual benefit - the farmers learn from the extension workers, and the extension system is reinforced in a dynamic exchange.

The project model have been developed over the years and nowadays it is applied all over the world in countries like Brazil and China, India, Mozambique and Zimbabwe.

Activities in Farmers Club in Wulong (China) in 2015

Wulong County is a county level subdivision of Chngqing municipality-county, in South-central China. The Farmers Club started at Wulong as transfer of experience, based on three years work in the other parts of the county of Chongqing.

Beside these 6 villages, the project is engaged in work with three more institutions: Haokou municipal authorities, county and provincial poverty alleviation offices. It is expected that in the course of the year, 3 villages from Baoluan township will join the project.

Fighting Epidemics

In 2015 HPPB is a partner in 12 TCE projects in five countries: China, India, Mozambique, Namibia and Zimbabwe. HPPB implements three and a half year TCE project in Butuo county (China). The project is sponsored by European Commission

"Only the people can liberate themselves from AIDS – the epidemic". This simple statement is the foundation of Total Control of the Epidemic (TCE) project. The TCE approach have been developed over the years by applying it in various socio cultural contexts, e.g. in rural area as well as in slums of mega polis. TCE projects are used by HPP member organizations all over the world. The health systems in the countries hardest hit are no match for the challenges of the HIV virus, despite multiple efforts to meet them. The people themselves, when knowledgeable and mobilized, are capable of acquiring a crucial impact on the proliferation and the transmission of the disease.

TCE is the approach and the practice with which Humana People to People member organizations wage war against infection of deadly viruses and the diseases following in its wake. Since 2000, the TCE Field Officers have talked with 10 million people: one to one - with the goal of each person taking control, individually and together with others: not to become infected or not to spread the disease and to live a long and healthy life.

Activities in TCE Butuo (China) 2015

The aim of TCE Butuo project is to mobilize 2,880 people for voluntary testing and counselling via home-based rapid testing in a 6 months pilot project to aid the containment of localized HIV/AIDS epidemics and the reduction of HIV prevalence/incidence or containment of the low-level epidemic by preventing secondary transmission from source population to the general population. The project covers 5 townships in Butuo County - Luogu, Juesa, Meisa, Longtan, Eliping.

This is first ever pilot project, where local non-governmental health workers Field Officers reach out to remote rural communities and offer health education and voluntary counselling and home based testing in people’s homes. This pilot project was funded by the China-U.S. Cooperation - Global AIDS Program which is a cooperation between the United States Centres for Disease Control and Prevention (U.S. CDC) and the Chinese Centre for Disease Control and Prevention (China CDC).

Child Aid

In 2015 HPPB is a partner in implementation of 25 Child Aid and Community Development projects in seven countries: China, India, Guinea Bissau, Congo, Namibia, Zambia and Zimbabwe.

Child Aid or Community Development project is community capacity building project. Families and entire local community engages in an all-inclusive program, acknowledging that to raise a child, the entire community must be strengthened. Families are brought together to deal with issues of health and sanitation, income generation, education, district development, environmental awareness and participation of children. Child Aid project is organized along 10 lines of activities, starting with family income and health. Other lines are directed towards nutrition, hygiene, environment protection, infrastructure and other issues to improve the conditions where needed. Primary school in the operation area is an important cooperation partner - children, teachers and parents alike. Most of Child Aid projects work in rural surrounding. The project concept proved to be very effective also when applied in working with people of suburbs of mega polis, like Delhi.

Activities of Child Aid project in Bissora, Guinea Bissau in 2015

The project activities started three years ago and covers villages in rural area of Bissora. To improve the precarious situation of children the project is planned to implement these activities: